Thomas Szasz, Relentless Freedom Fighter, Dead at 92

I am sorry to report that Thomas Szasz, the great libertarian critic of coercive psychiatry, the "therapeutic state," and the war on drugs, died over the weekend at his home in Manlius, New York. He was 92.

Szasz, a Reason contributing editor and professor emeritus at Upstate Medical University in Syracuse, was driven throughout his long and remarkably productive career by what he called his "passion against coercion," especially the medicalized versions that recast repression as treatment. His radical critique of psychiatry, laid out in the 1960 American Psychologist essay "The Myth of Mental Illness" and then in a book of the same name the following year, may be more relevant today than ever, as the field grows to encompass every sin and foible despite its shaky empirical foundation. Szasz argued tirelessly that psychiatric labels, as nothing more than names attached to sets of behavioral criteria, should not be used to strip people of their freedom or relieve them of their responsibility. Defenders of mental-health orthodoxy dismiss this critique more often than they address it, but even when they engage Szasz's arguments they cannot refute his crucial point about the arbitrariness and subjectivity of psychiatric taxonomy.

In addition to opposing involuntary psychiatric treatment and the insanity defense, Szasz objected to medically sanctioned state interference in what ought to be private decisions, ranging from drug use to suicide. His critique of drug prohibition, which delved into frequently ignored issues such as the nature of addiction and the justification for the mandatory prescription system, went beyond cost-benefit analysis to reveal the essential immorality of using force to stop people from altering their consciousness with politically disfavored chemicals. He brought the same kind of penetrating analysis to the subject of "public health" paternalism, interventions aimed at minimizing morbidity and mortality by discouraging risky behavior. He was a powerful influence on my own work in both of these areas, and I will always be grateful for his courage and insight.

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Isn’t there another side to his legacy? We deinstitutionalized a lot of people in the 70s. And judging from the street people I see in every American city I have been to, I would say there was a cost to that. I will feely admit that psychiatry is often a cargo cult that does its patients little or no good. But when I see the women in my town who lives on the streets in total fifth talking to a collection of stuffed animals, I have a hard time believing mental illness is just a myth or that throwing that woman and millions like her out on the streets was a good or humane thing to do.

Thomas Szasz was funded by the Church of Scientology. It drives me nuts to see libertarians who generally ahbor pseudo-science latch on to his “research” simply because it comports to libertarain political philosophy. I think there are legitimate discussions to be had regarding the implication of mental illness, particularly as it pertains to the state. But that doesn’t mean we shoudl pretend that mental illness doesn’t exist. It’s bullshit when the left selectively cherry-picks its science to comport to its politics. It’s bullshit when the right selectively cherry-picks its science to comport to its politics. The championing of Thomas Szasz as a scientist shows that libertarians can be guilty of the same bullshit.

Well, I think there’s a distinction to be made between obvious physiological brain disorders, such as schizophrenia, and classifying merely unconventional opinions and behaviors as “illness”. Szasz, as far as I could tell, was largely campaigning against the later.

Likewise, Szasz has never denied that organic conditions–say, Alzheimer’s disease or untreated syphilis–can have an impact on thought and behavior. But he insists on evidence of an underlying physical defect, and he emphasizes that behavior itself is never a disease. “Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish,” he writes on his Web site

And that is just bunk. He is right that psychiatry has failed to understand human behavior. But to say that every person who does not have some underlying physical defect can never be categorized as “mentally ill” flied in the face of reality. You see these people every day. They don’t all have untreated syphilis or such. They are for whatever reason mentally ill and cannot care for themselves or cope with living on their own.

I understand that involuntary commitment can be abused. And maybe throwing these people out into the streets is the price worth paying to prevent that abuse. But that is not the argument he is making. He is making the argument that the person who can’t function in society or care for themselves and refuses commitment is not mentally ill. And that is just bullshit.

You’re absolutely right John. Remember, the first step is to admit you have a problem. Next, you need to commit yourself. Your words are obvious evidence you are “mentally ill”, notwithstanding that there is no medical reason to believe you are. Because hey, it’s obvious you can’t cope with real life, just like those people you describe. Therefore, you should be committed, even if it’s against your will.

That is just nonsense sophistry you are putting out because you have no answer. Yeah, it is really hard to determine who is “mentally ill”. But the fact that it is hard doesn’t mean there is no such thing.

We took tens of thousands of people who were totally incapable of caring for themselves and kicked them out on the street in name of pretending they were just like the rest of us. And this guy was behind a lot of it. There are two ditches here. One side is abusing psychiatry to throw political dissidents in prison. The other ditch is living in la la land where there is no such thing as anyone who is too sick to help themselves.

That is just nonsense sophistry you are putting out because you have no answer.

No, I’m just mocking your reasoning. It can be used against anyone who’s considered to be making the “wrong” choices, choices that society finds threatening. Which is Zsasz’s whole point.

Yeah, it is really hard to determine who is “mentally ill”. But the fact that it is hard doesn’t mean there is no such thing.

Which isn’t what Zsasz argues.

We took tens of thousands of people who were totally incapable of caring for themselves and kicked them out on the street in name of pretending they were just like the rest of us. And this guy was behind a lot of it.

Below, Richman already replied to this claim:

Szasz never advocated that people who did not want to leave the institutions should be forced to leave. Quite the contrary. Some who were “liberated” could remember no other homes.

It can be used against anyone who’s considered to be making the “wrong” choices, choices that society finds threatening.

Yes, exactly. If we say things like “the behavior speaks for itself,” that is exactly the problem Szasz attacked. It is not just that it is “really hard” to decide who is mentally ill, but that either there is a pathology or there isn’t, and if there isn’t, there is no way to decide if someone is “mentally ill” other than via subjective evaluation. Which opens the whole door into who decides what is deviant?which is now not just deviant but “diseased.”

From rts’s links below to the Wikipedia page on the Rosenhan experiment, a 1975 criticism of the study claims “that as psychiatric diagnosis relies largely on the patient’s report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms”: “If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood… If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

A bleeding ulcer is a real, actual thing-in-the-world, not just a behavior. It’s not that doctors can’t get it wrong, but that there is a “right” to compare the wrong to, out in the world, outside of the deviant’s behavior and the evaluator’s subjectivity.

He is making the argument that the person who can’t function in society or care for themselves and refuses commitment is not mentally ill.

No, he’s saying that without some sort of pathology to let us, and more importantly the PATIENT, know they’re ill, we really DON’T know they’re mentally ill. And if the patient refuses treatment? THAT ALREADY HAPPENS WITH PHYSICAL AILMENTS. People can and do refuse treatment for things, even things that can kill them. We don’t force THEM to undergo medical treatment. Unless we should always override poor medical decisions from patients, that’s a terrible argument.

“But to say that every person who does not have some underlying physical defect can never be categorized as “mentally ill” flied in the face of reality”

I’m no medical scientist, but I am compelled to say that people like that do have some physical neurological problem beyond a simple behavior. Its not their thought process that’s fucked up. Their though process is fucked up because of something else that is physical.

IIRC, Szasz pointed out that it was telling that once previously “mental” illnesses are shown to have a physiological basis, they’re declassified as mental illnesses. So I think he did make such a distinction.

He did, and he was very concerned with classification and its consequences. It’s well worth reading him, and he’s quite readable. I highly recommend The Myth of Mental Illness. A taste:

Since all systems of classification are made by people, it is necessary to be aware of who has made the rules and for what purpose. If we fail to take this precaution, we run the risk of remaining unaware of the precise rules we follow, or worse, of mistaking the product of a strategic classification for a “naturally occuring” event. I believe this is exactly what has happened in psychiatry during the past sixty or seventy years, during which time a vast number of occurrences were reclassified as “illnesses.” We have thus come to regard addiction, delinquency, divorce, homosexuality, homicide, suicide, and so on almost without limit, as psychiatric illnesses. This is a colossal and costly mistake.

He is right that the classifications were abused. But he is wrong that there is no such classifications. We clearly put people in prison for things that are not and should not be crimes. But that fact does not mean there is no such thing as crime. He makes the same mistake with mental illness. Just because doctors classified too many things as mental illness does not mean nothing is ever a mental illness.

That is so easily abused as to be practically meaningless. Drapetomania, “runaway slave syndrome”, was understood in the same way. “They ran away? Oh well, that speaks for itself. Those poor, ill subhumans”.

I’d like to say that the only time that behavior speaks for itself is when they’re a direct danger to themselves or someone around them, but that’s a bit fuzzy. You may consider wandering the streets to be a “direct danger to someone”. But I can’t say that choice, poor as it is, should be overridden by force.

I’ve known someone who was schizophrenic, and could not be trusted to be unmedicated, because she would run around naked and attack people with knives. There was no way to a) guarantee her safety or the safety of others and b) communicate with her to know what she’s thinking.

On the other hand, I know someone else who was considered mentally ill, who had to be released because she wasn’t a danger to herself or others. For months she wandered the streets of Chicago, living in homeless shelters. But since she a) wasn’t in danger of harming herself or others, and b) could still be communicated and reasoned with, there wasn’t anything that could be done. Despite her very poor behavior, it still isn’t clear that she was mentally ill, since there’s no way to determine pathology. She’s now living normally again and has a steady job, all without being medicated or coerced in any way.

In the first case, there isn’t much to do with her either than 1) incarcerate her or 2) medicate her. When it became readily available, Option 2 was the best answer. She even behaved the way she did before, mostly. In the first case, however, the issue wasn’t so drastic. Is wandering the streets good for her? No. Was it enough of a reason to incarcerate her or medicate her against her will? I’ve thought about this, but I think the answer here is also no. Since she refused any help, and wasn’t a danger to anyone, coercion wasn’t the answer.

But that fact does not mean there is no such thing as crime. He makes the same mistake with mental illness. Just because doctors classified too many things as mental illness does not mean nothing is ever a mental illness.

Which isn’t what he argues. He never said people can’t have medical illnesses that affect their behavior. You even acknowledge this above, but here you contradict that.

We should determine if someone is mentally ill based on medical evidence something is wrong with them, which is just what he advocates. You assume that because people make choices that are bad for them, they are “mentally ill”, but you’re making the same mistake he rails against.

Someone who won’t leave their house, or chooses to wander the streets, may certainly have something psychologically wrong with them, but that is NOT the same as being medically ill, any more than someone who has horribly disfiguring piercings is medically ill.

There are two ways “psychology” as a “science” can be used. It can be used to attempt to help, and it can be used to pathologize and imprison. Used as the former, there is nothing malicious about it even if it is a remarkably imprecise “science”. Used as the latter it is a weapon and evil and has been used by many a regime to incarcerate the non-compliant.

I am unfortunately too busy helping see the 54 patients in our psychiatric emergency room with “imaginary” mental illnesses to argue with you all today.

I have said it before, the DSM is a joke. But schizophrenia, mania and severe depression are very real biologic illnesses. In our ER, we don’t treat any of the rest of the malarkey they pathologize in the DSM, that is the domain of psychotherapists. But the three diseases above are enough to keep us overcrowded 24/7 though, and all patients are seen by physicians only.

I am unfortunately too busy helping see the 54 patients in our psychiatric emergency room with “imaginary” mental illnesses to argue with you all today.

Huh? Is there more to his argument than what I see here? “[A]rgue with” him “all day”? Where have you argued with him at all? He’s saying that it shouldn’t be used to “pathologize” normal behaviors as an excuse to imprison them. I don’t see anywhere that he impugned psychiatry as a whole, just it’s use as a means of social control.

But schizophrenia, mania and severe depression are very real biologic illnesses.

As to schizophrenia, no one here has said otherwise. Mania and depression are a bit trickier of course (pathologically speaking), but when someone’s endangering their own life (e.g. attempted suicide), or is asking for medical help, that’s certainly within the realm of medical attention. Again, I don’t see that Episiarch has suggested otherwise.

Yeah, but new readers might have missed them. My family got Reason subscriptions when I was a kid, so I saw him a little bit. But before I started reading Reason.com this past year, I still didn’t see much about the guy (I’m not well read for real-world stuff. My tastes lean toward fantasy/science-fiction).

My previous comment was marked as spam. Often, websites with incompetent staff are evacuated in droves. Take Salon, for example. I’m so glad Greenwald left. Kudos to Tom Szasz, though my reverie is a little punctured right now.

I just found out Dr Szasz passed away.I read most of his books (including his translation of Karl Krause ) after first stumbling upon Ceremonial Chemistry. He was easily my favorite libertarian writer, even more so than Heinlein.